MEDICARE: BELLANICE MARIE SANTANA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	694	NC

General Provider Information

NPI Number	:	1649829144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BELLANICE MARIE SANTANA BCBA

Provider Business Mailing Address
First Line	:	13523 PLAZA ROAD EXT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-8921
Country	:	US
Telephone Number	:	980-202-7428
Fax Number	:

Provider Business Practice Location Address
First Line	:	13523 PLAZA ROAD EXT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-8921
Country	:	US
Telephone Number	:	980-202-7428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	12/19/2023

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